The development and validation of effective medical and health-related interventions have been longstanding targets of intervention research and intervention researchers. However, the average amount currently spent on every American exceeds $7,000 per year. This amount continues to increase and consume an ever-increasing proportion of the gross national product. The trend must be altered. While effectiveness is a constant target of intervention research, cost effectiveness has been a less frequent but increasingly important research target. Cost benefit and cost effectiveness analyses may become an essential and expected elements of all late-stage human intervention research. The overall goal of the proposed project is to determine the cost-effectiveness of the telephone-supported Rural Breast Cancer Survivors (RBCS) Intervention (a Psycho-educational support intervention) compared to the usual care available to rural dwelling breast cancer survivors after the first course of cancer treatment. The RBCS was adapted specifically for rural-dwelling survivors from of an intervention package that had previously been shown to be effective in an NIH funded trial. To achieve the overall goal and address the specific aims of the proposed project, the research team has been carefully selected to provide a formidable combination of experience and expertise in intervention research, cancer survivorship, cost-effectiveness analysis and health economics to address the various facets of the proposed project. The specific aims are to: (1) determine the effects of the RBCS on quality of life;(2) To determine the cost of implementing the RBCS;(3) determine the impact of participating in the RBCS on (a) health care utilization, (b) cost of care and (c) participant out-of-pocket costs, and;(4) determine the incremental cost effectiveness of the RBCS compared to usual care. In the proposed analyses, effectiveness will be measured by the improvement in quality of life for RBCS participants compared to usual care (control) participants. Benefits will be compared to the costs of delivering the intervention as well as to potential additional costs that may derive as a result of participating in the RBCS. These include the costs of better adherence to surveillance guidelines paid by health care payers and by participants out of pocket. It also includes costs for additional services RBCS participants may be encouraged to use as a result of the support intervention, for example counseling. The cost-effectiveness analysis will compare incremental costs and outcomes of the RBCS to determine whether the incremental gain in quality of life is worth the allocation of resources to deliver and participate in this intervention. Analyses will be done from the perspectives of society, breast cancer survivors and third party payers. Study results will ideally not only allow better determinations of the costs of maintaining the intervention package as a service and the specific effects on participants, but also will provide important cost-effectiveness data to better inform consumers, payers and policy. PUBLIC HEALTH RELEVANCE: The will allow us to examine the impact of the Rural Breast Cancer Survivors on health care use, costs of care, and out of pocket expenses.